Prompts for handwashing

ABSTRACT

A method and apparatus that systematically prompts staff, patients and visitors at care facilities to perform handwashing at critical time periods, for example after touching a toilet flush handle or upon entering or leaving a patient&#39;s room. A plurality of detectors are used to sense whether a person has entered an area and to determine whether the person has cleansed their hands within a predetermined period of time before entering the area or leaving the area. If it is determined that the person has cleansed their hands within the predetermined period of time, no prompting message is generated. If it is determined that the person has not cleansed their hands within the predetermined period of time, an audio/visual warning message is generated.

[0001] This patent application claims benefit of U.S. Provisional PatentApplication S. No. 60/263,159, filed Jan. 23, 2001.

FIELD OF THE INVENTION

[0002] The present invention relates to an automated prompting devicethat increases the frequency of handwashing and decreases infectionrates.

BACKGROUND OF THE INVENTION

[0003] Infections, including nosocomial infections, are prevalent in allpatient care facilities including hospitals and nursing homes. Theseinfections pose a significant health risk to hospitalized patients bydelaying healing, extending the length of hospitalization and increasingthe human and financial cost of care. A nosocomial infection has beendefined as “a localized or systemic condition that 1) resulted fromadverse reaction to the presence of an infection agent or its toxin and2) was not present or incubating at the time of admission to thehospital.” Research reveals that several types of microorganisms can betransferred by hand to live hosts, thereby producing nosocomialinfections.

[0004] Nosocomial infections delay healing, extend the length ofhospitalization and increase the cost of care. Each year, approximately2.4 million Americans acquire a nosocomial infection and 100,000 personsdie as a result of such infections.

[0005] Handwashing is the linchpin of infection control. Failure toconduct handwashing after toileting or prior to contact with a patientplaces patients and health care workers at great risk for thedevelopment of nosocomial infections. While health care workers play apowerful role in reducing nosocomial infections, they have also beenimplicated in contributing to their increase by failing to performhandwashing prior to contact with a patient and after handlingcontaminated materials. Although health care workers are required toparticipate in annual infection control in service inspections, there isa discrepancy between classroom knowledge and applied knowledge ofinfection control. This discrepancy suggests that innovative strategiesin infection control must be created in order to reduce the rate ofnosocomial infections.

[0006] U.S. Pat. No. 5,945,910 discloses a handwashing and monitoringsystem that uses a sensor that signals the dispensation of a cleaningagent from a dispenser. A dual mode monitoring and reporting moduleincludes an input element, an output element, a processor and memory.The module accepts data identifying an employee, receives a signalindicating dispensation of the cleaning agent and stores compliance datarecords.

[0007] U.S. Pat. No. 5,870,015 discloses an apparatus in which toiletuse is monitored and audible messages are produced that instruct usersof the toilet regarding steps in toilet use and hygiene. The apparatusincludes a housing that is removably attached to the toilet. A switcharm is coupled with the toilet handle and sends an activity signalindicative of the switch arm position to electronic circuitry thatactivates the audible messages.

[0008] U.S. Pat. No. 5,812,059 discloses a method and system forenhancing hygiene. An activating device is located outside a work area,a hand cleaning station is located near the work area, and adeactivating device is associated with the hand cleaning station. Uponleaving a food handling area, an indicator worn by a worker is activatedwhen the worker is near the activating device. The indicator isdeactivated only when it is determined that the worker has used the handcleaning station.

[0009] U.S. Pat. No. 5,202,666 discloses an automated device used toremind employees to wash their hands after toileting. Sensors are wornon credit card sized badges and mounted in bathroom ceilings andattached to soap dispensers and sinks. When an employee enters thebathroom, the ceiling unit sensor activates a blinking light on thebadge. The light is deactivated once the employee pumps the soapdispenser and stands in front of the sink for at least 15 seconds.

[0010] U.S. Pat. No. 4,986,144 discloses a hand washing alert warningsystem designed to warn someone to wash their hands. A door activatesystem is armed when the door to the wash facility is opened or a toiletis flushed and is deactivated when it is determined that the person haswashed their hands.

[0011] However, these existing systems have several problems associatedwith them. For example, they are relatively complex, there is no way toeffectively force employees to wear badges, the batteries in the badgeshave to be replaced frequently and there is no way to monitor what anemployee does between the time they wash their hands and the time theyreturn to their work area.

SUMMARY OF THE INVENTION

[0012] The present invention provides a method that includes sensing aperson in a first area and determining whether the person has cleansedtheir hands before leaving the area. If it is determined that the personhas cleansed their hands, this information is sent to a database. If itis determined that the person has not cleansed their hands beforeleaving the first area, it is then determined whether the person hasentered a second area. If it is determined that the person has enteredthe second area, it is then determined whether the person has cleansedtheir hands. If it is determined that the person has not entered thesecond area, it is then determined whether the person has cleansed theirhands in a third area after leaving the first area. If it is determinedthat the person has cleansed their hands after entering the second orthird area, this information is sent to the database. If it isdetermined that the person has not cleansed their hands after enteringthe second area or the third area, a warning is generated. Additionally,if it is determined that the person has not cleansed their hands afterthe warning is generated, this information is sent to the database.

[0013] The present invention also includes an apparatus having a centralprocessor for increasing the frequency of handwashing. The presentinvention includes a receiver and a communication link connecting thecentral processor and the receiver. A first sensor is located near theopening of a first area for determining entry and exit from the firstarea. A second sensor is located inside the first area for determiningmovement within the first area. A module is located inside the firstarea for emitting audio and visual signals. A third sensor is located atan opening of a second area located adjacent to the first area fordetermining entry and exit from the second area. A fourth sensor islocated inside the second area for determining toilet usage. A fifthsensor is located inside the second area for determining sink usage. Asixth sensor is located near the opening of the first area fordetermining cleanser dispenser usage. The sensors communicate with thereceiver via radio waves and the module communicates with the centralprocessor via the AC power lines.

BRIEF DESCRIPTION OF THE DRAWINGS

[0014] This invention will be described in detail with reference to theaccompanying drawings wherein:

[0015]FIG. 1 is an illustration of the patient room with an adjoiningbathroom according to a preferred embodiment of the present invention.

[0016]FIG. 2 is an illustration of a non-patient room according to apreferred embodiment of the present invention.

[0017]FIG. 3 is an illustration an audio message delivery systemaccording to another embodiment of the present invention.

[0018]FIGS. 4a, 4 b and 4 c are flowcharts illustrating the processsteps for FIGS. 1 and 2.

DETAILED DESCRIPTION OF THE INVENTION

[0019]FIG. 1 illustrates a schematic view of a system according to apreferred embodiment of the present invention. The system includespatient room 1 and adjoining bathroom 3. As shown, located in patientroom 1 is a passive infrared motion (PIR)/thermal detector 5 and aspeaker/appliance module assembly 7. Located proximate to patient room 1is an infrared (IR) beam breaker 9/switch 9 a and a dispenser 11/switch11 a. Located inside bathroom 3 is toilet 13/switch 13 a, sink 15/waterflow switch 15 a and bathroom door 17/door status switch 17 a. Computer19 is connected via conventional modes such as radio waves or radiofrequency signals (RF) to switches 9 a, 11 a, 13 a, 15 a, 17 a and PIR5. Receiver 23 is connected to computer 19 via a standard communicationsconnection 25 such as RS-232.

[0020] In a preferred embodiment, door status switch 17 a transmits asignal to computer 19 indicating whether bathroom door 17 is open orclosed, the toilet flush switch 13 a transmits to computer 19 when thetoilet handle has been depressed, the sink water flow switch 15 atransmits to computer 19 when water is flowing from the sink faucet, andthe dispenser switch 11 a transmits to computer 19 when the dispenser 11is used.

[0021] IR beam breaker 9 comprises for example, an infrared transmitterwith a receiver located on one side of the door and a reflector locatedon the other side of the door. The detector 5 detects motion insidepatient room 1. An IR beam is transmitted across the door, reflected atthe other side, and detected at the transmitter to indicate that aperson has crossed the threshold. Alternatively, other detection devicessuch as pressure sensitive floor mats with electrical contacts or otherappropriate sensing configurations may be used instead of IR beambreaker 9.

[0022] In a preferred embodiment, to detect toilet use, toilet flushswitch 13 a is attached to the toilet tank with a magnet on the handlefor tank type toilets. The magnet and switch 13 a are arranged so thatflushing the toilet moves the magnet near the switch 13 a, triggering asignal to computer 19 that the toilet has been flushed. Alternatively,for toilets that flush by operation of a handle protruding from a pipethat can be moved in any direction to flush the toilet, a thinconductive sheet of metal may be wrapped around the toilet handle. Theconductive sheet of metal is electrically insulated from the toilethandle. Wires from the insulated metal sheet and from the pipe intowhich the handle fits are connected to switch 13 a. When the toilet 13is flushed the conductive metal sheet touches the pipe, completing anelectrical circuit. Switch 13 a then sends a signal to computer 19 thatthe toilet 13 has been flushed.

[0023] In a preferred embodiment, sink water flow switch 15 a is anon-conducting sleeve attached to the sink faucet including electrodesplaced inside. The electrodes are electrically isolated from the aeratorbody and are placed directly in the water stream when the water isflowing. Ordinary tap water is conductive because of dissolvedelectrolytes and therefore, water flowing over the electrodes conductsenough current between them to close the sink water flow switch 15 a.Thus, a signal from the switch 15 a indicates water flowing in the sinkindicating handwashing. In another embodiment, handwashing may beinferred from use of a dispenser 11/switch 11 a located near sink 15that is used to directly sense the dispensation of a cleanser, such assoap and to provide the appropriate signal to computer 19.

[0024] The dispenser 11 consists of a tube containing for example,liquid alcohol-based foam and has a downward pointing spout on thebottom and may be mounted in a bracket on the wall adjacent patient room1. To detect foam dispensing, the dispenser's spout may be attached to aswitch 11 a or switch 11 a may be placed on the wall behind thefoam-dispensing nozzle, in such a way that a person dispensing foam willpress switch 11 a. The foam dispenser may be mounted on a bracket onmicroswitches, which are mounted on the wall and connected in parallelto switch 11 a. Alternately, a pressure actuated switch may be mountedon the wall in such a way that a person must press it to dispense foam.When a person presses the foam dispenser nozzle one or moremicroswitches close. The switches are connected to a status switch thattransmits a signal indicating foam use to the computer. In yet anotherembodiment, a thermal detector may be mounted under the foam dispenserto note when a person places their hands on the spout to dispense foam.

[0025] At least one computer is used to implement the present invention.The computer receives and processes data from all sensors.Alternatively, additional computers may be used as required if the radiowaves from the sensors are not strong enough to penetrate the wallsbetween the computer and the most distant hospital rooms. In this casethe additional computers are installed at separate locations from thefirst computer. Each computer can process data from specific areas.

[0026] In a preferred embodiment the computer 19 communicates withsensors/switches via RF signals. However, it should be understood thatradio waves may be replaced by higher frequency signals, opticalsignals, hard wires, or any well known communications system or method.

[0027] In a preferred embodiment, thermal detector 5 is an infraredmotion detector that detects time variations in differences intemperature in different directions in the detectors field of view. Thedevice observes the energy radiated by objects in their vicinity, but donot emit any radiation of their own, except for the RF signalstransmitted to computer 19. When the thermal detector detects motion, anRF signal is sent indicating the detector's new state and a uniqueaddress. The switches and sensors preferably contain a radio transmitterthat transmits their unique address and a signal indicating an “on”status when their terminals are closed and a signal indicating an “off’status when those terminals are opened. Receiver 23 detects the signaland transmits it to computer 19 via RS-232 cable or any well knowcommunication means. Computer 19 can then determine which switch changedstate, and the new state as well.

[0028]FIG. 2 is a schematic of a soiled utility room 30 illustrating afurther usage of the present invention. As shown, located in the room isa detector 5, a sink 15/water flow switch 15 a, and a speaker/powersupply/appliance module 7. Attached to door 32 is door status switch 32a. A message is played in the soiled utility room 30 reminding thoseleaving the room to wash their hands if they open the door to leavewithout having washed their hands. Additionally, door status switch 32 amay be used with an IR beam or an outer floor mat.

[0029] One embodiment of the speaker/power supply/appliance module 7 isillustrated in FIG. 3. A module 40 such as the X10 by Home AutomationSystems™, Inc., is connected to an ordinary 110 volt wall socket. Thesignal is sent from computer 19 using the X10 Serial Port Interface 42and the X10 Interface 44 shown in communication between computer 19 andthe 110 volt line. A 12-volt DC power supply 46 is connected to module40. The power supply output cable is connected to the power socketspeaker 48. Alternatively, a flashing lighted sign may also be connectedto module 40.

[0030]FIGS. 4a, 4 b and 4 c are flowcharts illustrating the systems ofFIGS. 1 and 2. As shown in FIG. 4a, when a person leaves the patientroom at Step S1, and if it is determined at Step S2 that the personwashed their hands within a predetermined time before leaving the room,this information is recorded at Step S3 and no warning is given. If itis determined at Step S4 that a person did not wash their hands at StepS2 but instead entered a nearby room, then at Step S5 it is determinedif they washed their hands in that room after a predetermined time. Ifis determined at Step S4 that the person did not enter another room butat Step S6 it is determined that the person did wash their hands inanother area such as the hall after a predetermined time, then thisinformation is recorded in Step S3 and no warning is given. If it isdetermined at Step S5 that the person washed their hands after apredetermined time in the second room then this information is sent tothe central database at Step S3 and no warning is issued. If it isdetermined at Step S5 that the person did not wash their hands in thesecond room after a predetermined time, then a warning is issued forexample, in the hall and in the room. At Step S8, if it is determinedthat the person washed their hands after the warning, this informationis sent the database at Step S3. If it is determined at Step S7 that theperson washed their hands in the hall after the warning, thisinformation is sent to the database at Step S3.

[0031] As shown in FIG. 4b, when a person leaves the bathroom at StepS10, and it is determined at step S20 that they flushed the toilet whilein the bathroom, and it is also determined that the person washed theirhands in the bathroom at Step S50, then no prompt is issued and theinformation is recorded at Step S30. If it is determined at Step S50that a person used the toilet in Step S20, but that the person did notwash their hands before leaving the bathroom at Step S10, an appropriatewarning, such as “wash your hands please” is issued at Step S60. It isthen determined at Step S70 if the person washed their hands in responseto this prompt and the information is recorded at Step S30. If it isdetermined at Step S50 that a person used the toilet and subsequentlyflushed the toilet, then a warning is issued at Step 60 if the personhas not washed their hands after the last flush, even if they havewashed their hands after a previous flush.

[0032] As shown in FIG. 4c, when a person leaves the patient room atStep S100, and if it is determined at Step S500 that the person washedtheir hands before leaving the room, this information is recorded atStep S300 and no prompt is given. If the person does not wash beforeleaving the room and it is determined at Step S200 that the personwashed their hands after leaving the room, then this information isrecorded at Step S300 and no prompt is issued. If it is determined thatthe person did not wash their hands at Step S200 but entered a nearbyroom at Step S500, it is determined whether they washed their hands inthat room. If is determined at Step S500 that the person washed theirhands in the second room, this information is sent to the centraldatabase at Step S300 and no prompt is issued. If it is determined thatthe person did not wash their hands at Step S500, a warning prompt isissued in the hall and in that room as Step S800. At Step S900, if it isdetermined that the person thereafter washed their hands. Thisinformation is sent to the central database. If it is determined at StepS400 that the person did not enter another room, a warning prompt isissued in the hall at Step S600. If it is subsequently determined atStep S700 that the person thereafter washed their hands, thisinformation is sent to the database at Step S300.

[0033] For example, when a person leaves the soiled utility room 30illustrated in FIG. 2, if the person has already washed their hands,then only a record of the event is made. If the person has not washedtheir hands, when they leave they will hear a verbal prompt such as“wash your hands, please.”

[0034] In one embodiment, verbal prompts or audible prompts are used.However, although verbal prompts are effective, they may disturbpatients. Verbal prompts can be used in areas such as the soiled utilityroom and staff bathroom and similar rooms without patients.Alternatively, visual prompts, such as flashing lights, may also beused. For example, a flashing light or flashing lighted sign may be usedat all times and verbal prompts during daylight. Visual prompts may beused in rooms where voices are objectionable. Additionally, anycombination of visual, audible, sensory, vibrating, or any otherappropriate prompt is within the scope of the invention.

[0035] Computer 19 is preferably equipped to convert digital files intoan analog representation of speech. The audio signal is transmitted tospeakers in hospital rooms and hallways via low voltage wires. Multiplespeakers are controlled from a single computer, sending a message to oneor more speaker at a time. In a preferred embodiment, messages are sentfrom the computer to the speakers via radio waves. Messages may be sentto just one speaker via radio waves having a frequency detected by oneparticular speaker.

[0036] In the preferred embodiment, data is collected and files areedited via a dedicated telephone line in communication with a centrallocation. Computer 19 communicates with a computer at the centrallocation so as to allow remote editing of files and remote datacollection from computer 19 without physically being present at thepatient facility. Alternatively, data may be collected and files editedon site.

[0037] The present invention determines when a person enters or leavesan area by comparing the sensor turn on times according to Table 1 andTable 2. Table 1 shows the sensor status when a person enters the roomfrom the hall. “X” indicates time on the order of 5 seconds in thepreferred embodiment, but is adjustable. TABLE 1 Entry to room from hallOn within the last X Sensor\Status On now? seconds? IR Beam Breaker 9 NoYes Detector 5 Yes Irrelevant

[0038] In Table 1, the IR beam breaker 9 indicates that an object was inthe door way within the last X seconds and detector 5 indicates thatthere is now something just inside the doorway. TABLE 2 Exit from roomto hall On within the last X Sensor\Status On now? seconds? IR BeamBreaker 9 Yes Irrelevant Detector 5 No Yes

[0039] In Table 2, IR beam 9 is activated, indicating that a person isin the doorway. Detector 5 is shown as being activated within the last Xseconds, indicating that a person has recently been just inside thepatient's door.

[0040] Various embodiments of the invention have been disclosed herein.According to the present invention, a device senses a person enteringinto a room. A determination is made as to whether the person hascleansed their hands within a predetermined period of time. If it isdetermined that the person has cleansed their hands, the information issent to a database. If it is determined that the person has not cleansedtheir hands, a warning signal is generated and as a result, the personis prompted to cleanse their hands.

[0041] Although various embodiments have been discussed, it is to beunderstood that while certain forms of the present invention, such asmeans for signaling, audio/visual warnings, have been illustrated, theinvention is not to be limited to the specific forms or arrangements ofparts described or shown. Although an inpatient environment has beendescribed herein, the method and system is also applicable to otherenvironments where hygiene is important such as food service or day carefacilities. Given the above disclosure, many other features,modifications and improvements will become apparent to one skilled inthe art.

What is claimed is:
 1. A method of prompting comprising the steps of:(a) maintaining a computer database; (b) sensing a person in a firstarea; (c) determining whether the person has cleansed their hands beforeleaving the area; (d) if it is determined that the person has cleansedtheir hands, sending this information to the database; (e) if it isdetermined that the person has not cleansed their hands before leavingthe first area, determining whether the person has entered a secondarea; (f) if it is determined that the person has entered the secondarea, determining whether the person has cleansed their hands; (g) if itis determined that the person has not entered the second area,determining whether the person has cleansed their hands in a third areaafter leaving the first area; (h) if it is determined that the personhas cleansed their hands after entering the second or third area,sending the information to the database; (i) if it is determined thatthe person has not cleansed their hands after entering the second areaor the third area, generating a warning; and (j) if it is determinedthat the person has not cleansed their hands after the warning isgenerated, sending the information to the database.
 2. The method ofclaim 1 further comprising the step of: (k) if it is determined thatthere is no need for the person to cleanse their hands, no warning isgenerated and sending this information to the database.
 3. The method ofclaim 1 wherein the step of generating generates the warning signal asat least one of an audio signal or a visual signal.
 4. A method ofhandwashing comprising the steps of: detecting a person in a restroom;monitoring whether the person flushes a toilet; if it is determined thatthe person has not flushed the toilet, sending the information to acentral database; if the person flushes the toilet, determining whetherthe person cleanses their hands within a predetermined period of timebefore leaving the restroom and sending this information to the centraldatabase; if it is determined that the person has not cleansed theirhands within the predetermined period of time, generating a warningsignal and sending this information to the central database; and if itis determined that the person has not cleansed their hands after thewarning signal was generated, sending this information to the centraldatabase.
 5. The method of claim 4 wherein the step of generatinggenerates the warning signal as at least one of an audio signal or avisual signal.
 6. The method of claim 4 further comprising the step ofdetermining whether the toilet has been flushed a subsequent time beforethe person has left the restroom.
 7. The method of claim 6 furthercomprising the step of determining whether the person has cleansed theirhands an additional time.
 8. The method of claim 7 further comprisingthe step of generating a subsequent warning signal if the person has notcleansed their hands an additional time and sending this information tothe central database.
 9. An apparatus for increasing the frequency ofhandwashing comprising: a central processor; a receiver; a communicationlink connecting the central processor and the receiver; a first sensorlocated near the opening of a first area for determining motion throughthe opening; a second sensor located inside the first area fordetermining movement within the first area; a module located inside thefirst area for emitting audio and visual signals; a third sensor locatedat an opening of a second area located adjacent to the first area fordetermining entry and exit from the second area; a fourth sensor locatedinside the second area for determining toilet usage; a fifth sensorlocated inside the second area for determining sink usage; a sixthsensor located near the opening of the first area for determiningcleanser dispenser usage; and wherein the sensors communicate with thereceiver via radio waves or hard wires and the module communicates withthe central processor via AC or radio waves.
 10. The apparatus of claim9 wherein the first sensor is an IR beam breaker switch.
 11. Theapparatus of claim 9 wherein the second sensor is a thermal detector.12. The apparatus of claim 9 wherein the audio signal is generated by aspeaker.
 13. The apparatus of claim 9 wherein the visual signal isgenerated by an illumination device.
 14. The apparatus of claim 9wherein the third sensor and fourth sensor are magnetic contactswitches.
 15. The apparatus of claim 9 wherein the fourth sensor furthercomprises a conductive material attached to the toilet handle.
 16. Theapparatus of claim 9 wherein the fifth sensor is a sink water flowswitch.
 17. The apparatus of claim 16 wherein the sink water flow switchis comprised of an aerator and at least one electrode.
 18. The apparatusof claim 9 wherein the sixth sensor is a switch in connection with thecleanser dispenser.
 19. The apparatus of claim 18 wherein the cleanseris at least one of liquid soap and anti-septic foam.
 20. A system forpromoting handwashing comprising: a computer system for maintaining acomputer database; a first sensor for sensing a person in an area; asecond sensor for sensing the person's movement to another area; adetermining unit for monitoring the first and second sensor output andfor determining whether the person has cleansed their hands and agenerating unit for generating a warning signal based on the determiningunit output; and a transmitting unit for transmitting information to thecomputer system based on the output of the determining unit and thegenerating unit.
 21. The system of claim 20 wherein the generating unitgenerates the warning signal as at least one of an audio signal or avisual signal.
 22. A system for increasing handwashing comprising: adetecting unit for detecting a person entering a restroom; a monitoringunit for monitoring whether the person flushes a toilet while in therestroom; a determining unit for determining whether the person flushesthe toilet and cleanses their hands within a predetermined period oftime; a generating unit for generating a warning signal after thepredetermined period of time has expired if the person has not cleansedtheir hands; and a transmitting unit for transmitting to a centraldatabase whether the person has cleansed their hands within thepredetermined period of time.
 23. The system of claim 22 wherein thegenerating unit generates the warning signal as at least one of an audiosignal or a visual signal.
 24. An apparatus for reporting and monitoringcomprising: a means for processing; a means for receiving; acommunication means connecting the processing means and the receivingmeans; a first sensing means located near the opening of a first areafor determining entry and exit from the first area; a second sensingmeans located inside the first area for determining movement within thefirst area; an audio and visual emitting means; a third sensing meanslocated at an opening of a second area located adjacent to the firstarea for determining entry and exit from the second area; a fourthsensing means located inside the second area for determining toiletusage; a fifth sensing means located inside the second area fordetermining sink usage; a sixth sensing means located near the openingof the first area for determining cleanser dispenser usage; and whereinthe sensing means communicate with the receiving means via radio wavesand the audio and visual emitting means communicates with the processingmeans via AC.
 25. The apparatus of claim 24 wherein the first sensor isan IR beam breaker switch.
 26. The apparatus of claim 24 wherein thesecond sensor is a thermal detector.
 27. The apparatus of claim 24wherein the audio signal is generated by a speaker.
 28. The apparatus ofclaim 24 wherein the visual signal is generated by an illuminationdevice.
 29. The apparatus of claim 24 wherein the third sensor andfourth sensor are magnetic contact switches.
 30. The apparatus of claim24 wherein the fourth sensor further comprises a conductive materialattached to the toilet handle.
 31. The apparatus of claim 24 wherein thefifth sensor is a sink water flow switch.
 32. The apparatus of claim 31wherein the sink water flow switch is comprised of an aerator and atleast one electrode.
 33. The apparatus of claim 24 wherein the sixthsensor is a cleanser dispenser unit.
 34. The apparatus of claim 33wherein the cleanser is selected from the group consisting of liquidsoap and anti-septic foam.
 35. An apparatus for increasing the frequencyof handwashing comprising: a central processor; a receiver; acommunication link connecting the central processor and the receiver; afirst sensor located near the opening of a first area; a second sensorlocated inside the first area; a communication module located inside thefirst area; a third sensor located at an opening of a second area; afourth sensor located inside the second area; a fifth sensor locatedinside the second area; a sixth sensor located near the opening of thefirst area; and wherein the sensors communicate with the receiver viaradio waves or hard wires and the module communicates with the centralprocessor via AC in order to indicate whether handwashing has occurred.36. A system for promoting handwashing comprising: maintaining means formaintaining a computer database; first sensing means for sensing aperson entering an area; second sensing means for determining theperson's movement to another area; determining means for monitoring thefirst and second sensing means and for determining whether the personhas cleansed their hands within a predetermined period of time beforeentering the room; generating means for generating a warning signal atan expiration of the predetermined time period; and transmitting meansfor sending whether the person cleansed their hands to the database. 37.The system of claim 36 wherein the generating means generates thewarning signal as at least one of an audio signal or a visual signal.38. A system for increasing hygienic behavior comprising: detectingmeans for detecting a person entering a restroom; monitoring means formonitoring whether the person flushes a toilet while in the restroom;determining means for determining whether after the person flushes thetoilet the person cleanses their hands within a predetermined period oftime; generating means for generating a warning signal after thepredetermined period of time has expired if the person has not cleansedtheir hands; and sending means for sending the information to a centraldatabase if it is determined that the person has not cleansed theirhands within the predetermined period of time.
 39. The system claim 38wherein the generating means generates the warning signal as at leastone of an audio signal or a visual signal.